Method and apparatus for patient protection against vessel rupture from balloon-tipped catheters

ABSTRACT

A safety inflation apparatus for preventing full inflation of a catheter balloon in a small body cavity of lesser internal diameter than that of the fully-inflated catheter balloon. The apparatus includes a safety reservoir which inflates to absorb excess fluid volume from a catheter inflation device (such as a syringe) when the catheter balloon comes into contact with the wall of the small cavity, thereby preventing damage to the cavity wall and injury to the patient. In one embodiment of the invention, sensors and cooperating electronic displays are employed to provide an indication of the operating state of the system as the catheter balloon is inflated, and in another embodiment of the invention, the catheter inflation device is automatically actuated and driven, in addition to employing sensors and displays.

This application is a continuation-in-part of copending U.S. Pat.application Ser. No. 07/419,828, filed Oct. 11, 1989, now U.S. Pat. No.5,007,919.

BACKGROUND OF THE INVENTION

The present invention relates generally to medical devices, and moreparticularly to a method and apparatus for preventing rupture of bloodvessels resulting from inflation of catheter balloons.

The flow directed balloon-tipped pulmonary artery catheter wasintroduced in 1970. While permitting easy bedside monitoring of cardiacfunction in critically ill patients, this device has resulted in certaincomplications, some benign and self-limiting, and others moresignificant. The latter include arterial and ventricular arrhythmias,balloon rupture, pulmonary infarction, bacteremia and intracardiacknotting. Rupture of the pulmonary artery is generally viewed as themost serious complication associated with the use of theseballoon-tipped catheters. This is particularly a problem in patientsover the age of sixty years, in whom it is believed that reduced vesselelasticity and increased fragility of tissues reduce the vesselrupturing pressure below the normal inflation pressures of the catheterballoons.

An explanation of a procedure employed with balloon-tipped catheterswill result in a better appreciation of the magnitude of the problem.Use of inflatable catheters for internally blocking various bodypassages is well known in the art. Pulmonary artery catheters havinginflatable balloons at their distal ends have been utilized in hundredsof thousands of procedures. The balloon, which in its uninflated stateapproximates the diameter of the catheter about which it is disposed, isinflated when desired by a gas syringe connected to the balloon channelor lumen of the catheter, which extends from outside the patient's bodyto the balloon.

To employ the catheter, a sheath is inserted in a suitable vein, such asthe jugular vein, and the tip of the catheter is inserted through thesheath into the vein, until it exits the sheath, whereupon the balloonis inflated to act as a float responding to blood flow to assist indrawing the catheter through the vein until the balloon reaches thepulmonary artery. At this point, the balloon becomes wedged in a branchof the artery, and when lodged in this manner may be utilized to monitorthe so-called "wedge" pressure of the artery via an oscilloscopeconnected to sensors in the catheter, all of which is known in the art.

After an initial wedge pressure reading is taken, the balloon isdeflated and the catheter normally left in place in anticipation ofsubsequent readings. It is to this portion of the procedure that it isbelieved most problems with vessel rupture are attributable, for thedeflation of the balloon at the distal end or "tip" of the catheterpermits the now-smaller diameter tip to drift or migrate into a smallerportion or branch of the artery. If the migration phenomenon occurs,when next balloon inflation is attempted, the balloon may be positionedin a vessel of smaller diameter and/or greater fragility than intended.As a result, the normal inflation pressure of the balloon is exceededdue to the inability of the balloon to expand to its normal inflateddiameter when injected with its specified volume of gas. Such balloonover-pressuring can result in catastrophic failure (rupture) of thevessel, generally resulting in rapid death of the patient.

Undue resistance to inflation of the balloon, which may indicate thatthe catheter tip is located in a small vessel, is a reason to terminateinflation attempts. However, such resistance, which may be transmittedto the practitioner through the "feel" of the plunger of the syringebeing utilized for inflation, is subtle and difficult to interpret.Since balloons by various manufacturers provide differing inherentresistance to inflation, resistance to inflation attributable to aballoon being wedged in a small vessel may not be recognized by the feelof the syringe. This problem is aggravated with the small syringestypically used to inflate catheter balloons, since high pressures areindistinguishable from normal pressures to the clinician due to thesmall cross-sectional area of the plunger provided for pressure feedbackfrom the catheter.

Pulmonary artery catheters of different manufacturers have widelydiffering balloon inflation pressures due to variations in thickness andlatex composition of the balloons. When a balloon does inflate inside avessel, it tends to "pop open" at a particular threshold pressure. Thestiffer the balloon, the higher is the threshold pressure, with anattendant greater likelihood of vessel damage.

The concept of a pressure relief valve or regulator was believed to beuseful in reducing the risk of vessel damage due to high balloonpressures because there is generally a 500 mm Hg difference between thenormal opening pressure of the balloon and the minimum rupture pressureof the vessel. Use of such a valve at the balloon inflation port of acatheter has been suggested, as in U.S. Pat. No. 4,439,185 in thecontext of a liquid-inflated vascular dilating catheter, but thepop-open effect of the balloon negates the usefulness of such a device.Specifically, as a balloon pops open and thereby increases its volume,internal pressure of the syringe/catheter/balloon system falls.Therefore, a relief valve set above the balloon pop-open pressureprovides no protection after the balloon has opened; if set below thepop-open pressure, the pressure relief valve would prevent ballooninflation. Moreover, a pressure relief valve does not give a visualwarning to the user that the catheter balloon has been inflated in asmall vessel. Gas from the inflation syringe or other means escapesthrough the valve, thus preventing high inflation pressures, but withoutnotice. If the catheter is subsequently inadvertently drawn backslightly to a larger diameter vessel, as often happens due to the motionof the heart or the patient, the balloon to vessel wall seal is lost andcannot be re-established in the larger vessel because the air or othergas required to do so has previously been vented through the pressurerelief valve and cannot be returned into the system.

The addition of a "dead space" or pressure absorption zone between thesyringe and the inflation port, such as has been suggested in U.S. Pat.No. 4,795,431, can be of use in limiting the maximum balloon pressure,as can the use of smaller than recommended gas volume for inflation, butboth have proven unsatisfactory. It has been empirically determined thatdevices incorporating dead spaces or pressure-absorption zones actuallyaggravates the vessel damage due to overpressure in certain diametervessels. Use of a smaller than recommended gas volume results in aninferior wedge blockage of vessels and an undesirable portion of thecatheter tip remains exposed, enhancing the potential for vesselperforation, especially during catheter insertion. If the catheter tipresides in a small vessel, dangerously high balloon pressures can stillresult, especially if the vessel's internal diameter is close to theballoon's pop-open diameter.

Other attempts to identify over-pressurization of catheter balloonsinclude external indicators or monitors associated with the catheter,such as indicator or "signal" balloons to provide the syringe operatorwith a tactile indication of the inflation pressure of the internalballoon, and pressure gauges. Both of these approaches, however, do notprovide overpressure protection. At best they give a warning, but onlyafter the patient has sustained significant injury from ballooninflation. Because of the pop-open effect of the balloon, a pressuregauge cannot indicate the actual pressure exerted on the vessel wall.

SUMMARY OF THE INVENTION

In contrast to the prior art, the present invention comprises amechanically simple device of robust design which provides a fail-safemechanism to prevent full inflation of a catheter balloon in a vesselsmaller in internal diameter than that of the fully-inflated balloon.

The safety inflation apparatus of the present invention comprises atubular conduit with a relief aperture extending through the wallthereof, and an inflatable elastomeric sleeve-like safety reservoirmember stretched thereabout and sealed to the conduit on both sides ofthe aperture. One end of the conduit is adapted to receive fluid from acatheter balloon inflation device, such as a syringe, and the other endof the conduit is adapted to dispense fluid to the inlet of the balloonchannel or lumen of a catheter. The safety reservoir member of theapparatus of the invention is slightly stiffer than the balloon of thecatheter, so that the catheter balloon preferentially inflates firstwhen located in a large vessel. However, if the vessel diameter is lessthan the normal inflated diameter of the catheter balloon, the catheterballoon expands only enough to contact the interior of the vessel wall,whereupon the safety reservoir member of the present invention inflatesto absorb the excess fluid volume from the syringe, thereby preventingrupture of the vessel. Observation of the inflated safety balloon aftersyringe plunger deployment indicates to the operator that the catheteris in a smaller vessel. Although the wedge pressure is accurate and thepatient's vessel has been protected, it may be important to retract andre-inflate the catheter in a larger vessel to prevent obstruction of thevessel by the catheter itself.

In one embodiment of the present invention, the conduit and safetyballoon are housed in a simple cylindrical plastic housing having afirst receptacle at the inlet end of the conduit to receive the luerconnector or nozzle of a syringe and a second receptacle at the outletend to connect to the catheter with which the invention is employed. Thehousing may be of clear non-collapsible plastic and the balloon a brightcolor so that the state of the balloon may be readily ascertained. Thisembodiment of the device may be produced very cheaply, and utilized onlyon a single patient prior to disposal.

In another embodiment of the invention, the conduit and safety balloonhave associated therewith a sensor to sense plunger position of thesyringe, a pressure sensor to sense leaks in the system as the plungeris deployed, and an inflation sensor for the safety balloon, allconnected to electronic display means for an immediate indication of theoperating state of the system. In this more sophisticated embodiment,additional information beneficial to the safety of the patient isimmediately available to the practitioner.

In yet another embodiment of the invention, the conduit and safetyballoon have associated therewith an automated syringe plunger driveapparatus, which is preferably also associated with a modified versionof the above-described embodiment employing sensors and an electronicdisplay. The arrangement of the automated plunger drive apparatus isadvantageous in that it provides a completely disposable fluid injectioncircuit by placing the conduit and safety balloon of the invention indirect fluid communication with the luer connector of the syringe andremoving the sensors and electronics from the fluid circuit. Thus, theproblem of sterilizing sensors and electronics is eliminated, andautomated operation of the syringe plunger frees the practitioner's timeand attention for other critical portions of the procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be more fully understood by one of ordinaryskill of the art through a review of the following detailed descriptionof the preferred embodiments of the invention taken in conjunction withthe accompanying drawings, wherein:

FIG. 1 depicts a balloon catheter of the type normally employed inpulmonary arteries;

FIG. 1A comprises an enlarged view of the distal end of the catheterafter the balloon is inflated;

FIGS. 2A-2D illustrate catheter placement in the pulmonary system of apatient and the phenomenon of migration;

FIGS. 3A and 3B comprise partial sectional elevations of a firstembodiment of the present invention showing operation of the inventionwhen inflation of the catheter balloon is attempted in large and smallvessels, respectively;

FIG. 4 comprises a schematic of a second embodiment of the inventionemploying electronic sensors;

FIG. 5 comprises an electronic schematic for the second embodiment ofthe present invention;

FIG. 6 is a graph depicting the inflation pressure/catheter balloondiameter relationship for an unconstrained balloon;

FIG. 7 is a graph depicting the inflation pressure/fluid injectionvolume relationship for a standard 1.5 ml catheter balloon inflated in a0.15 inch diameter (I.D.) rigid-wall tube with (dashed line) and without(solid line) the use of the apparatus of the present invention;

FIG. 8 is a graph depicting the inflation pressure (solid line) andcorresponding diameter (dashed line) of a standard 1.5 ml catheterballoon as it is inflated in a 0.15 inch diameter latex tube;

FIG. 9 is a graph depicting the inflation pressure (solid line) andcorresponding diameter (dashed line) of a standard 1.5 ml catheterballoon as it is inflated in a 0.15 inch diameter latex tube using theapparatus of the present invention;

FIG. 10 is a graph of pressure versus injected volume of air for anunrestrained standard 1.5 ml catheter balloon (lower solid line), theapparatus of the present invention alone (top solid line), and the twoutilized together (dashed line);

FIG. 11 comprises a schematic of a third embodiment of the inventionemploying an automatic syringe plunger drive in association withelectronic sensors.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

FIGS. 1 and 1A of the drawings illustrate a balloon 25 catheter 10 ofthe type generally referred to in the medical arts as a Swan-Ganzcatheter after the physicians who introduced the device and thetechnique of employing it in pulmonary arterial monitoring. Suchcatheters are available from, among others, Edwards Laboratories, Inc.,Santa Ana, California. Catheter 10 is of the quadruple channel or lumendesign, having four lumens or tubes 12, 14, 16, and 18 at its proximalor inlet end. Lumens 12-18 feed into a single insertion tube 20 atjunction 22. At the distal or innermost end 24 of insertion tube 20, asleeve-like latex rubber catheter balloon 26 is disposed about tube 20and sealed thereto at each end 28 and 30 of the balloon. Balloon 26 isinflated to its expanded diameter as shown in FIG. 1A via receipt ofpressurized gas through lumen 12 and an internal passage (not shown) ininsertion tube 20, which communicates with the interior of the balloon26 through a small aperture 32 extending through the wall of theinsertion tube 24. Lumens 14, 16 and 18 comprise, respectively, aproximal channel lumen, a distal channel lumen, and a thermistor lumen,all of which are conventional and are unrelated to the presentinvention.

Lumen 12 includes an inlet collar 36 having several tabs 34 adjacent itsmouth, and a valve (unnumbered) to shut off gas-flow to balloon 26.Conventionally, tabs 34 are utilized to secure collar 36 to the nozzleof a syringe. However, in the present invention, collar 36 is insteadsecured to the outlet of the housing for the safety balloon.

Referring to FIGS. 3A and 3B, catheter 10 is depicted schematically onthe left-hand side of the drawings as a single channel extending fromcollar 36 via insertion tube 20 to catheter balloon 26. Syringe 40having barrel 42 inside which plunger 44 may longitudinally move, isdepicted schematically at the right side of the drawings, arrow 46indicating the direction of plunger movement to feed gas to catheterballoon 26.

A first embodiment 50 of the safety inflation apparatus of the presentinvention is depicted in FIGS. 3A and 3B in series between collar 36 andsyringe 40. Nozzle or luer connector 48 of syringe 40 is inserted ininlet receptacle 54 of apparatus 50 in communication and in sealingengagement with the inlet end 52 of tubular relief conduit 56. Collar 36is inserted in outlet receptacle 58 and, via tabs 34 engaging withthreads 60 on the inside of receptacle 58, balloon channel or lumen 12is maintained in communication and sealing engagement with nozzle orluer connector 62 of apparatus 50 and thereby in communication with theoutlet end 64 of relief conduit 56. Sleeve-like safety reservoir 66 isdisposed about conduit 56 and is sealed thereto at each of itslongitudinal ends. Reservoir inflation relief aperture 68 extends fromthe interior of conduit 56 through the wall thereof between the ends ofsafety reservoir 66. Safety reservoir 66 comprises an elastomer,preferably a latex composition, stretched to preload the sleeve intension and to thereby minimize dead air space between the exterior ofconduit 56 and the interior of safety reservoir 66, and to ensure aconsistent, predictable predetermined inflation pressure.

As shown in FIGS. 3A and 3B, apparatus 50 may comprise a minimum numberof parts in this preferred embodiment, the device then being inexpensiveenough to produce so as to be disposable after a single use. Conduit 56may be of plastic, with safety reservoir 66, comprising (as noted above)a latex compound sealed after preloading to the exterior of conduit 56at each end of safety reservoir 66 via any means known in the art,including adhesive, heat-induced sealing or mechanical clamping. Nozzle62 and receptacle 60 can be made integrally of plastic with outletcollar 70, and the assembly adhesively sealed about outlet end 64 ofconduit 56. Inlet collar 72 and inlet receptacle 54 may be of similarintegral design and plastic construction, and adhesively sealed aboutinlet end 52 of conduit 56. A noncollapsible cylindrical barrel 74,which may be of clear plastic or other material to facilitate viewing ofthe inflation state of safety reservoir 56, is adhesively securedbetween inlet collar 72 and outlet collar 70 about conduit 56 and safetyreservoir 66. A small aperture 76 extends through the wall of outletcollar 70 to permit expansion of safety reservoir 66 without compressionof the air inside barrel 74.

Safety reservoir 66, as shown in FIGS. 3A and 3B, is connected to thegas supply from syringe 40, in parallel to catheter balloon 26, and isslightly stiffer than the catheter balloon 26, so that when catheterballoon 26 is located in a large arterial vessel or is otherwiseunconstrained, catheter balloon 26 responds to the inflation gas andinflates. In its open position, balloon 26 acts as a float, facilitatingthe passage of the catheter 10 through the heart 80 and into thepulmonary artery 82 (see FIGS. 2A through 2C). Turning again to FIG. 3A,catheter balloon 26 is shown "wedged" in pulmonary artery 82 in itsfully inflated mode, whereupon pressure readings may be taken by theclinician. It should be observed that catheter balloon 26 is notimposing any substantial radial pressure, and thereby stress, on thewalls of artery 82, as it contacts the vessel wall at a point of slightconstriction after balloon inflation, acting as a plug or cork in thevessel.

After an initial pressure reading has been taken by the clinician, it isestablished practice to deflate the catheter balloon 26 by opening thevalve in collar 36 associated with lumen 12, in order to permitcontinued blood flow through the pulmonary system and specifically thepulmonary artery. However, re-instituted blood flow may tend to carry or"migrate" the distal end 24 of insertion tube 20 to a smaller vessel 84(see FIG. 2D) downstream of the heart 80 and pulmonary artery 82. Ifinsertion tube 20 so migrates, catheter balloon 26 is precariouslylocated in a vessel 84 of much smaller diameter, in many instances of adiameter approximately the outer diameter of the uninflated balloon 26.When the clinician desires to re-inflate balloon 26 to take a secondwedge-pressure reading, the constriction of the smaller vessel about theballoon will prevent or restrict inflation, resulting in an unintendedpressure increase in balloon 26 and attendant stress on the vessel.

For example, if a 1.5 milliliter (ml) volume syringe is employed toinflate a catheter balloon of like normal inflation volume and, due toconstriction of the wall of small vessel 84 about a migrated balloon,the latter can be inflated to only, 0.3 ml, under the gas equation for aconstant temperature, P₁ V₁ =P₂ V₂, the pressure in the constrictedcatheter balloon 26 will be five times that in the syringe 40 when theplunger has been fully deployed, assuming no gas compression or internalvolume expansion elsewhere in the catheter system. Even allowing forsuch compression or volume expansion, it is readily apparent thatpressures in excess of the 900 mm Hg, known to cause vessel rupture inthe pulmonary arterial system, may almost instantaneously be achieved.Laboratory testing has shown that pressures of at least 1100 mm Hg caneasily be generated during balloon inflation The resistance to internalpressure provided by the catheter balloon affords only minimalprotection to the patient, absorbing only a small part of the 1100 mm Hgpressure, as the remaining pressure in the system is applied as apotentially injurious force directly to the confining vessel wall viathe surface area of catheter balloon 26 in contact therewith.

When the apparatus of the present invention is introduced betweensyringe 40 or other inflation means and balloon channel or lumen 12, analtogether different result is obtained in the above-describedsituation. Safety reservoir 66 is designed to have an inflation pressureof 600 mm Hg or less, at least fifty percent (50%) lower than the 900 mmHg minimum vessel damage pressure. As syringe plunger 44 is deployed inbarrel 42 of syringe 40, gas pressure is transmitted through reliefconduit 56 into balloon channel or lumen 2, into insertion tube 20 andsubsequently into catheter balloon 26 located in small vessel 84.Balloon 26 contacts the inner wall of vessel 84 in response to the gaspressure and, as noted above, is constrained against further inflation.Gas continues to be injected into the closed catheter system asdeployment of plunger 44 is continued. However, as system pressurerises, gas is relieved through relief aperture 68 as safety reservoir 66commences to inflate. The internal pressure in the system cannot exceed600 mm Hg, the maximum pop-open pressure of the safety reservoir. Thus,any excess gas which cannot be accommodated in catheter balloon 26 dueto the constraint of small vessel 84 is harmlessly relieved into safetyreservoir 66, avoiding injury to the patient. Of course, when catheterre-inflation is attempted in a desired location, such as pulmonaryartery 82 (see FIG. 2C), catheter balloon 26 inflates normally at asafe, low pressure, and safety reservoir 66 remains in its uninflatedstate.

Referring now to FIGS. 4 and 5, a second preferred embodiment 100 of thesafety inflation apparatus of the present invention will be described.Embodiment 100 includes a relief conduit 56, relief aperture 68 andsafety reservoir 66 identical to that of embodiment 50. In like manner,the inlet and outlet fittings to transmit gas to and from relief conduit56 may be identical to that of the first embodiment, and so will not befurther described, but the entire assembly will be referred to in FIG. 4generally by reference numeral 50.

In addition to the previously described elements of assembly 50,embodiment 100 includes an electronic sensing and display means, poweredby a power supply 102, preferably a 9 volt DC battery. The sensing meansof embodiment 100 include plunger deployment sensor 104, pressure switch106 and safety reservoir displacement switch 108. The display means ofembodiment 100 includes a system leak or balloon rupture display 110, asmall vessel display 112 indicative of the attempted inflation of acatheter balloon in a small vessel, and a balloon up display 114,indicative of proper inflation of the catheter balloon with no systemleaks. Power supply 102 and all of the foregoing sensing and displaymeans are interconnected by a circuit 116, primarily located on acircuit card. Circuit 116 is shown schematically in FIG. 5 of thedrawings, and the components thereof, including the sensing and displaymeans of embodiment 100, will be hereinafter described in conjunctionwith the operation of embodiment 100.

When embodiment 100 is to be utilized in catheter balloon inflation,on/off switch 120 (see FIG. 5) for the electronics is switched to its"on" position, and syringe 40 is sealingly engaged with the inlet 52 ofrelief conduit 56 and catheter 10, specifically balloon channel 12, withthe outlet 64 thereof. As plunger 44 is deployed, it passes betweeninfrared emitter (LED) 122 of plunger deployment sensor 104, blockingthe infrared waves previously sent to detector 124, which comprises aphototransistor. Prior to deployment of plunger 44, a completed circuitexists from power supply 102 through pressure switch 106, both viainfrared LED 122 to ground 130 and via rheostat-type biasing resistor128 and phototransistor detector 124 to ground 130. Switch 106 remainsin the position shown in solid line in FIG. 5 until there is greaterthan 150 mm Hg pressure sensed in relief conduit 56.

After plunger 44 is deployed, the aforementioned circuit throughphototransistor 124 is broken as phototransistor 124 becomesinoperative, no longer receiving infrared waves from emitter 122. Thisresults in three possible alternative additional circuit paths frompower supply 102 to ground 130, depending upon the existence of greaterthan 150 mm Hg pressure in relief conduit 56 and whether or not safetyreservoir 66 is inflated. If there is no pressure or pressure less than150 mm Hg in relief conduit 56, pressure switch 106 remains in theposition shown in FIG. 5, and a circuit is completed via transistor 132,red LED 134 and buzzer 136 in parallel, and safety reservoirdisplacement switch 108 to ground 130. This circuit completion resultsin the activation of red LED 134 and of buzzer 136 of balloon rupturedisplay 110, indicating rupture of catheter balloon 26 or other leak inthe syringe/catheter system.

If pressure switch 106 responds to an appropriate level of systempressure (>150 mm Hg), it moves to its dotted line position in FIG. 5,creating an alternate circuit path through either green LED 140,illumination thereof as balloon up display 114, indicating properinflation of catheter balloon 26, or yellow LED 142, illuminationthereof as small vessel display 112 being indicative of inflation ofsafety reservoir 66. The exact circuit path is dependent upon theposition of safety reservoir displacement switch 108. If catheterballoon 26 is inflating normally, safety reservoir 66 will remainuninflated and displacement switch 108 will remain in its solid-lineposition as shown in FIG. 5, indicating to the practitioner thatcatheter balloon 26 is inflated and in a large vessel and all is wellvia the illumination of green LED 140 of balloon up display 114. If,however, catheter balloon 26 is in a small vessel which constrains itsinflation, safety reservoir 66 inflates and displacement switch 108 istripped by contact with the inflating-balloon to its dotted-lineposition in FIG. 5, and the circuit is completed through yellow LED 142of small vessel display 112, the illumination of LED 142 warning thepractitioner that catheter balloon is wedged in a small vessel.

The electronic components of the system have not been described indetail, because all are available at retail supply houses, such as RadioShack, and the exact nature and specification of the power supply,LED'S, phototransistor, transistor, buzzer, and resistors employed inthe circuit are not material to the present invention 100 and selectionthereof is well within the skill of those in the art. Pressure switch106 need only respond to an appropriate pressure level (150 mm Hg) anddisplacement switch 108 to movement of safety reservoir 66 as itinflates. However, it has been found that an especially suitablepressure switch is available as reference number F4400 pressuremicroswitch from Air Logic.

Referring now to FIGS. 6-10 of the drawings, the difference in inflationcharacteristics of a typical air-inflated pulmonary artery catheterballoon with and without the use of the present invention.

FIG. 6 shows the pressure to inflation diameter relationship for theabove-referenced typical pulmonary artery catheter balloon as it isinflated to the recommended 1.5 ml inflation volume in an unconstrainedstate. As the first 0.75 ml of air is injected utilizing a syringe aspreviously described, internal balloon pressure rises from 0 to 450 mmHg as the gas in the syringe and catheter lumen is compressed. Duringthis phase there is no significant change in balloon volume, asevidenced by the dashed line on the graph. At a volume slightly greaterthan 0.75 ml, the balloon pop-open pressure is reached, the balloonrapidly expands, and pressure falls to about 260-270 mm Hg. As thesyringe is further deployed and additional gas volume added, the balloonfurther expands with very little change in pressure.

Referring next to FIG. 7, the catheter balloon of FIG. 6 is nextdisposed inside a rigid tube of 0.15 inches diameter, simulating aninelastic small vessel such as might be found in an elderly patient. As1.5 ml of gas is introduced into the catheter balloon, internal pressure(solid line) rises rapidly to almost 1200 mm Hg, due to the constraintof the surrounding tube. On the other hand, if the apparatus of thepresent invention is utilized with the catheter balloon as heretoforedescribed, the injection of air results in a maximum system pressure(dashed line) of approximately 500 mm Hg, due to the accommodation ofthe excess pressure by the expansion of the safety reservoir of thepresent invention.

FIGS. 8 and 9 taken together provide another example of enhancedcatheter balloon performance and system safety. Again, as in previousexamples, a catheter balloon is inflated to 1.5 ml volume, but this timeinside a 0.15 inch internal diameter latex tube, designed to simulate avessel having some elasticity. In FIG. 8, the reader will note that thestandard catheter balloon still reaches a maximum internal pressure(solid line) of about 1000 mm HG (versus almost 1200 mm Hg in FIG. 7)prior to falling to about 730 mm Hg as the balloon and latex vessel popopen and expand to a 0.40 inch final diameter. In FIG. 9, using theapparatus of the present invention, balloon pressure (solid line)reaches only a maximum of 525 mm Hg and a final diameter (dashed line)of 0.17 inches. The enhancement in patient safety is self-evident fromthe lower pressure and smaller diameter of the catheter balloon.

Finally, FIG. 10 depicts inflation pressure curves of a standardcatheter balloon (thin lower solid line), the safety reservoir of theapparatus of the present invention (thick top solid line), and thepressure of the total system (dashed line) as described above, as thepresent invention is used in combination with the catheter as describedabove with an unrestrained catheter balloon. The standard balloon abovereaches about 450 mm Hg maximum internal pressure as the system isinjected with 1.5 ml of air. The safety reservoir of the presentinvention reaches about 550 mm Hg. The two in combination result in asystem pressure of about 430 mm Hg due to the commencement of pressureaccommodation by the safety reservoir.

Thus, it can be seen from the above graphic examples that the apparatusof the present invention has virtually no effect on catheter balloonperformance if inflation thereof occurs in large vessels (FIG. 6) as thesafety reservoir never comes into play, having a pop-open pressuregreater than that of the catheter balloon. However, when the catheterballoon is constrained in a small vessel (FIGS. 7, 8, 9 and 10), asignificant reduction in system pressure is effected using the presentinvention, with an attendant increase in patient safety.

To state the benefits of the present invention in another manner,utilization thereof provides a closed-system pressure relief mechanismwhich does not degrade the performance of a catheter balloon in itsintended function, and accommodates catheter migration between large andsmall vessels while providing an inflation reserve. If the catheterballoon moves from a small vessel to a large one after the inflation gasis injected into the system, gas in the safety reservoir moves back intothe now-unconstrained balloon due to its lower pop-open pressure, andexpands the balloon to its inflated design diameter.

It has been established that the preferred inflation pressure for thesafety reservoir of the present invention is about 100 mm Hg higher thanthat of the catheter balloon with which it is used. Thus, if catheterballoons of differing pop-open pressures from different manufacturersare to be utilized with the present invention, it is desirable topreload the safety reservoir sleeve of the present invention to anappropriate level and choose an appropriate safety reservoir sleevematerial and wall thickness to provide a 100 mm Hg delta pressure.

FIG. 11 of the drawings depicts a third preferred embodiment 200 of thesafety inflation apparatus of the present invention. Embodiment 200includes the components of embodiment 50, which are numberedaccordingly, as well as those of the circuit of embodiment 100, exceptwhere substitutions are hereinafter indicated. In addition, embodiment200 includes plunger drive assembly 202.

Embodiment 100, while providing useful information to the practitioner,employs an inflation fluid circuit (see FIG. 4) wherein syringe 50 feedsrelief conduit 56 through a conduit (unnumbered) and by pressure switch106 located within the housing of embodiment 100, within which apparatus50 is also contained. Thus, the entire assembly, including electronics,must be re-sterilized between uses, the cost of embodiment 100 makingdisposal after one use prohibitive. Of course, apparatus 50 might beremoved from the housing, but this still leaves a conduit and associatedpressure switch 106 in contact with the injected fluid.

Embodiment 200 removes the fluid circuit from its associatedelectronics, and further provides the aforementioned plunger drive 202.

Plunger drive assembly 202 comprises a solenoid 204, which includesreciprocable drive rod 206 surrounded by a magnetic solenoid coil 208,as is known in the art. The travel of drive rod 206 is limited bycontact of shoulder 209 against stop 210, which also serves as a guidefor the smaller diameter portion 212 of drive rod 206. Stop 214, whichsurrounds and guides the larger diameter portion 216 of drive rod 206,serves as a constraint for one end of return spring 211 surroundingdrive rod 206, which is threaded or otherwise secured to plunger drivearm 220. The other end of return spring 218 acts upon plunger drive arm220, which accommodates the head 222 of plunger 44 of a syringe 40 incavity 224. Of course, other means to secure plunger head 222 to drivearm 220 are contemplated. Solenoid coil 208 is powered by a battery pack226, which also serves as a power supply 102 for the modified circuit ofembodiment 100, disposed on control circuit board 228.

Modified circuit 100 replaces fluid pressure switch 106 of FIGS. 4 and 5with mechanical switch 106'; and microswitch 108 with infrared emitter(LED) 122' and detector 124', which comprises a phototransistor.Alternatively, a laser diode emitter/receiver set might be employed inlieu of an LED and phototransistor, to avoid susceptibility to ambientlight. In embodiment 200, pressure in the fluid circuit is sensed bymechanical pressure switch 106', the advancement of plunger 44 intosyringe barrel 42 resulting in resistance if the inflation fluid circuitis closed and operable. Assist spring 230 biases syringe collar 232 awayfrom syringe mount 234, and against movement of plunger 44 into barrel42. When the biasing force of assist spring 230 is overcome, switch 106'is actuated by collar 232, moving to the dotted line position shown forswitch 106 in FIG. 5. If there is little or no pressure in the fluidcircuit, plunger 44 will advance but barrel 42 will not be pressedagainst syringe collar 232 with sufficient force to overcome assistspring 230 and actuate switch 106'; and red LED 134 and buzzer 136 willbe activated as the circuit through phototransistor 124 is broken by theadvance of plunger 44 in the same manner as previously described withrespect to embodiment 100. Plunger drive assembly 202 will also bedeactivated by actuation of switch 106' so as to avoid plungerdeployment when the fluid system is leaking or a catheter balloon hasruptured.

If catheter balloon 26 inflates normally in response to the advance ofplunger 44, the circuit through phototransistor 124' will remain closed,corresponding to the solid-line position of switch 108 in FIG. 5,wherein green LED 140 is illuminated. If catheter balloon 26 isconstrained by a small vessel, safety reservoir 66 inflates, blockingthe light beam from LED 122' to phototransistor 124' and resulting incompletion of the circuit corresponding in FIG. 5 to the broken lineposition of switch 108, actuating yellow LED 142 and warning thepractitioner that balloon 26 is wedged in a small vessel.

It should be noted that a timer switch as known in the art may beincorporated in the electronic circuit to actuate plunger drive assembly202 on a periodic basis, as is normal in such procedures. The switchmay, of course, be of the adjustable variety so as to vary the timing asdesired. Alternatively, solenoid activation and signals from sensors aswell as indicators may be connected to and controlled by a computer viaanalog-to-digital and digital-to-analog conversion circuitry as is knownin the art.

When solenoid coil 218 is powered, plunger 44 is advanced. When power isremoved, return spring 218 moves drive rod back to its initial position,which also moves drive arm 220 and plunger 44. To prevent syringe 140from being withdrawn from syringe mount 234 during withdrawal of plunger44 from barrel 42, moveable (rotatable) ears 236 mounted on syringecollar 232 engage shoulder 238 on syringe barrel 42. Of course, springclips or other means for securing barrel 42 to mount 234 may beemployed.

It should also be noted that the speed of advance of plunger 44 intobarrel 42 is relatively unimportant in embodiment 200, due to thepresence of apparatus 50. Thus, stepper motors or other expensive priorart means for providing slow and/or incremental plunger advance orcatheter balloon inflation are unnecessary. It should also be understoodthat other means, such as pneumatic or hydraulic means for advancingplunger 42, may be employed in lieu of a solenoid.

Finally, it is contemplated that the inflation fluid circuit, whichnormally employs air, may be opened to the atmosphere via an aperture240 in the barrel 42 of syringe 40 at the desired location for aspecific injection volume. Using aperture 240, small leaks in the fluidsystem which do not adversely affect a single balloon inflation cycle,but which may adversely affect repeated inflation attempts with a closedsystem, are overcome. In effect, the withdrawal of plunger 42 pastaperture 240 permits the fluid circuit to recharge or refill to capacityso that the full desired volume of air will be injected upon eachdeployment of the plunger.

While the preferred embodiments of the present invention employsleeve-like safety reservoirs sealed to and surrounding coaxiallydisposed conduits, it is not so limited. For example, a sleeve or tubecould be stretched (pre-loaded) at an angle away from the conduit andinflated at one end, the other being closed. A diaphragm could bepressure loaded at the outside to yield at a desired pressure in thesystem. Alternatively, a spring-loaded piston could be used in acylindrical reservoir to accommodate excess pressure. However, all ofthe alternative embodiments described above are not preferred, due totheir increased manufacturing cost, more variable pressure responsecharacteristics, and in the latter case, frictional losses.

Thus, it is apparent that a novel and unobvious safety inflationapparatus has been developed for utilization with balloon catheters.While being described in the context of a Swan Ganz pulmonary arterycatheter, it is not so limited, but may be employed with any type offluid-inflated catheter. Many additions, deletions and modifications tothe preferred embodiments as described wherein will be readily apparentto and may be made by one of ordinary skill in the art without departingfrom the spirit and scope of the claimed invention.

What is claimed:
 1. A safety inflation apparatus for use with a catheterinflation apparatus comprising a syringe having a plunger slidablewithin a barrel, for preventing inadvertent inflation in a small bodycavity of a catheter balloon having a predetermined inflation pressurethreshold, said safety inflation apparatus comprising:tubular reliefconduit means including first receptacle means adapted for sealingengagement with said catheter inflation means, second receptacle meansadapted for sealing engagement with a balloon channel of a catheterhaving said balloon at the distal end thereof, and a relief apertureextending through the wall of said relief conduit means in communicationwith the interior of a sleeve-like inflatable safety reservoir meansdisposed about and sealed to said relief conduit means at either side ofsaid relief aperture between said first and second receptacle means,said safety reservoir means having an inflation pressure thresholdgreater than that of said catheter balloon; and means for directlydetecting the physical deployment of said plunger within said syringebarrel.
 2. The apparatus of claim 1, further including pressure switchmeans for sensing internal pressure of said safety inflation apparatusand operable in response thereto, said pressure switch means being in afirst position when sensed pressure is below a predetermined level, andin a second position when sensed pressure is at or above a predeterminedlevel.
 3. The apparatus of claim 2, further including a first displaytriggered at said pressure switch means first position when said plungerdeployment detection means detects syringe plunger deployment.
 4. Theapparatus of claim 3, further including display means being triggered atsaid pressure switch means second position when said plunger deploymentdetection means detects plunger deployment.
 5. The apparatus of claim 4,wherein said apparatus further includes safety reservoir displacementswitch means having a first and a second position, said displacementswitch means first position being responsive to said safety reservoirmeans in an uninflated state, and said displacement switch means secondposition being responsive to said safety reservoir means in an at leastpartially inflated state; andsaid display means comprises second andthird displays, said second display being triggered by said firstdisplacement switch position, and said third display being triggered bysaid second displacement switch position.
 6. A safety inflationapparatus for use with a catheter inflation apparatus comprising asyringe having a plunger slidable within a barrel, for preventinginadvertent inflation in a small body cavity of a catheter balloonhaving a predetermined inflation pressure threshold, said safetyinflation apparatus comprising:tubular relief conduit means includingfirst receptacle means adapted for sealing engagement with said catheterinflation means, second receptacle means adapted for sealing engagementwith a balloon channel of a catheter having said balloon at the distalend thereof, and a relief aperture extending through the wall of saidrelief conduit means in communication with the interior of a sleeve-likeinflatable safety reservoir means disposed about and sealed to saidrelief conduit means at either side of said relief aperture between saidfirst and second receptacle means, said safety reservoir means having aninflation pressure threshold greater than that of said catheter balloon;plunger drive means for deploying said plunger in said syringe barrel;return spring means for withdrawing said deployed plunger form saidsyringe barrel when said plunger drive means is deactivated; and plungerdeployment detection means for detecting the deployment of said plungerwithin said syringe barrel.
 7. The apparatus of claim 6, wherein saidplunger drive means comprises a drive rod having a solenoid coildisposed thereabout, said drive rod being secured to said plunger fordeploying said plunger in response to activation of said solenoid coiland resulting movement of said drive rod.
 8. The apparatus of claim 6,further including syringe mount means for securing said barrel of saidsyringe in a fixed position.
 9. The apparatus of claim 8, furtherincluding a pressure switch means for sensing internal pressure of saidsafety inflation apparatus and operable in response thereto, saidpressure switch means being in a first position when sensed pressure isbelow a predetermined level, and in a second position when sensedpressure is at or above a predetermined level.
 10. The apparatus ofclaim 9, wherein said pressure switch means comprises a switch forsensing resistance to plunger deployment within said barrel.
 11. Theapparatus of claim 10, wherein said syringe mount means includes syringecollar means secured to said syringe barrel and having biasing meansassociated therewith against said syringe mount means in opposition tothe direction of plunger deployment, said pressure switch being disposedin parallel with said biasing means so as to be actuatable only when theforce of plunger deployment exceeds the resistance of said biasingmeans.
 12. The apparatus of claim 6, further including a first displaytriggered at said pressure switch means first position when said plungerdeployment detection means detects syringe plunger deployment.
 13. Theapparatus of claim 12, further including display means being triggeredat said pressure switch means second position when said plungerdeployment detection means detects plunger deployment.
 14. The apparatusof claim 13, wherein said apparatus further includes safety reservoirdisplacement switch means having a first and a second position, saiddisplacement switch means first position being responsive to said safetyreservoir means in an uninflated state, and said displacement switchmeans second position being responsive to said safety reservoir means inan at least partially inflated state; andsaid display means comprisessecond and third displays, said second display being triggered by saidfirst displacement switch position, and said third display beingtriggered by said second displacement switch position.
 15. The apparatusof claim 14, wherein said displacement switch means comprises a lightemitter and a light receiver disposed in opposition across said reliefconduit means with said inflatable safety reservoir means disposedtherebetween, inflation of said safety reservoir means obstructing lightemitted from said light emitter, said light receiver means beingresponsive to said obstruction to change said displacement switch meansfrom its said fixed position to its said second position.
 16. A safetyinflation apparatus for use with a catheter inflation apparatuscomprising a syringe having a plunger slidable within a barrel, forpreventing inadvertent inflation in a small body cavity of a catheterballoon having a predetermined inflation pressure threshold, said safetyinflation apparatus comprising:tubular relief conduit means includingfirst receptacle means adapted for sealing engagement with said catheterinflation means, second receptacle means adapted for sealing engagementwith a balloon channel of a catheter having said balloon at the distalend thereof, and a relief aperture extending through the wall of saidrelief conduit means in communication with the interior of a sleeve-likeinflatable safety reservoir means disposed about and sealed to saidrelief conduit means at either side of said relief aperture between saidfirst and second receptacle means, said safety reservoir means having aninflation pressure threshold greater than that of said catheter balloon;and plunger deployment detection means including a light emitter and alight receiver disposed in opposition across said syringe barrel, thedeployment of said plunger in said barrel obstructing light emitted fromsaid light emitter and said light receiver being responsive to saidobstruction to detect deployment of said plunger in said barrel.